ACAM Integrative Medicine (IM) Blog

Preconference Exhibition

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Our mini-tradeshow and breakroom.

Live from San Diego

We're enjoying some great weather, great education and great people at the ACAM Spring 2009 Education Summit.  Our first paperless event is a success with only 1/2 as many workbooks printed as last year and attendees using their laptops to view slides, charts & graphs in high-resolution PDF.  Our outdoor lunches take place on the bay overlooking the San Diego Skyline.

Important Notice from IACP & P2C2 on the Status of the Former House and Senate Estriol Resolutions

In 2008, we saw great success with resolutions supporting access to estriol with over 62 supporters in the U.S. House of Representatives and the U.S. Senate!

However, at this time, H. Con Res. 342 and S. Con. Res. 88, the estriol resolutions introduced in 2008, are no longer active.  With every new Congress, each and every piece of legislation must be reintroduced. Both of these resolutions were introduced in the 110th Congress (during the 2007-2008 session of Congress) during the year 2008.  In January 2009, a new Congress will convene; this will be the beginning of the 111th Congress. Since this is the case, the resolution numbers formerly assigned to the estriol resolutions will soon be assigned to new legislation, probably on a subject completely unrelated to this issue. Thus, action alerts on the resolutions have been discontinued at this time.

For information on the resolutions, our success, and an overview of those legislators who supported our cause and supported our efforts to ensure your continued access to estriol, please click here.

Please note that IACP is reviewing options for the 111th Congress to ensure continued access to estriol. IACP and P2C2 will keep members closely informed about our activities as they occur.

New Enzyme Complex Isolated From Earthworms Is Potent Fibrinolytic:

Lumbrokinase Has Anti-Platelet, Anti-Thrombotic Activity

By Edwin Cooper, Ph.D., Sc.D., Distinguished Professor, Laboratory of Comparative Immunology at UCLA, Editor-in-Chief of eCAM, an Oxford University Press journal

When the rains surge through southern California, a confetti of earthworms is washed out of the soil. I lift the worms onto grass so they can find their way home--these creatures whose potent medicinal properties I have spent forty years studying.

The earthworm's antioxidant, immune-boosting, and clot-dissolving “medicine chest” is as powerful as that of any plant and even many pharmaceuticals. Earthworms have managed to survive for millions of years despite the constant threat of extinction by microbial pathogens. If we can begin to understand their remarkable capacities, we might design similar strategies to assist our own survival.

I have often wondered if earthworms are the creatures who first demonstrated a functional dichotomy in evolution: they evolved to be able to clean up the battlefield after having killed foreign invaders. They have cells that, much to my wondering eyes, look very much like human natural killer cells and neutrophils when examined with cytofluorimetric analysis and microscopy. I may sound a little eccentric when I tell you that my excitement over my beloved creatures is immense--I believe they hold healing treasures for us all.

In research I did in Modena in the late 1990's, I discovered that earthworm leukocytes can recognize human cancer cells as foreign and then kill them. Electron microscopy showed the astonishing “cinematography” of earthworm cells becoming incredibly active, throwing out “pseudopodia”, and literally tearing apart cancer cell membranes from a human cell cancer line named K562. In fact, in all the time I've studied earthworms, I've never once been able to induce cancer in them. I could irritate them only to the point that they formed inflammatory lesions.

As Charles Darwin once wrote, “It may be doubted whether there are many other animals which have played so important a part in the history of the world.”

Earthworms: Ancient Medicine, New Science

The last ten years have been a busy time for scientists exploring the medicinal treasures of earthworms. Laboratory, animal and clinical human studies have isolated enzymes and compounds that have proven to be potent fibrinolytics.

In healthy human volunteers, an enzyme complex isolated from earthworms increased levels of tissue plasminogen activator (t-PA) and consequently, fibrinolytic activity--without harmful side effects. In a study in 2000 the complex was found to be beneficial for ischemic stroke, without increasing the risk of excessive bleeding as other anticoagulants can. Using spectrofluorimeter and flow cytometry, a third study found that this complex has both anti-platelet activity (by reducing calcium release), anti-thrombotic activity (by reducing intercellular adhesion molecule-1) and anti-apoptotic activity (by inhibiting a specific pathway). All these activities, the researchers conclude, were “remarkably regulated.”

Earthworms have a long history in folk medicine--as far back as the 1300's. In ancient Burma and Laos, smallpox victims bathed in water where earthworms had been soaked. Worms were boiled in water with salt and onions and the broth given to women with postpartum weakness or difficulty nursing. In Iran dried earthworms were prescribed to help treat jaundice, and American Cherokee Indians used earthworm poultices to draw out thorns. According to the most famous ancient Chinese materia medica, earthworms could treat hemiplegia (a condition where half of the body is paralysed), fever, and blood clots.

Worms produce unique and potent molecules. One of my first research papers proved that earthworms have an immune system powerful enough to destroy other earthworm allografts, xenografts, but never autografts (an autograft is your own body's graft; allograft is a graft of foreign material from your own species; and a xenograft is a graft from another species, such as a pig heart valve into a human). Earthworms can kill bacteria and lyse foreign cells; their body fluid contains leukocytes that are as varied as those of many vertebrates. This is in spite of the fact that, unlike us, earthworms have no adaptive immune system, and do not form antibodies.

Earthworms happily crawl and munch their way through garbage teeming with bacteria and fungi, and not only fight off infection but alter that garbage so that their nitrogen and mineral-rich castings transform it into fertile, oxygen-rich soil. And, as practically every curious child knows, you can slice some earthworms and they will regenerate.

In the last ten years a number of the earthworm's clot-dissolving, lytic and immune-boosting compounds have been isolated and tested in laboratory and clinical studies. In particular, research has focused on clot-dissolving molecules. Fibrinolytic enzymes have been purified and studied from several species of earthworm, including Lumbricus rubellas and Eisenia fetida, and been found to be both potent and safe. This is very good news, since according to a 2008 conference report from the American Society of Hematology, thromboembolism impacts over one million Americans a year and is responsible for more deaths annually than breast cancer, HIV and motor vehicle crashes combined!

The Key to Lumbrokinase: Active Only in the Presence of Fibrin

Lumbrokinase (LK) is a group of six, novel proteolytic enzymes derived from the earthworm Lumbricus rubellas. In a 1992 study, a crude extract of the worm was shown to have a potent thrombolytic effect. The heat-stable, purified enzymes were first isolated in 1992 by Japanese researchers. The enzymes have potent fibrin-dissolving properties (fibrin is a protein deposited to create a mesh around a wound), decrease fibrinogen (a protein produced by the liver that is involved in the clotting cascade), lower blood viscosity and markedly reduce platelet aggregation.

Recent research suggests that LK may be effective in the treatment and prevention of ischemic heart disease, as well as myocardial infarction, thrombosis of the central vein of the retina, embolism of peripheral veins, and pulmonary embolisms.

One key, remarkable property of lumbrokinase is that, unlike the medications streptokinase and urokinase, it is only active in the presence of fibrin. Though it dissolves fibrinogen and fibrin very specifically, it hardly hydrolyzes other important blood proteins such as plasminogen or albumin. It has the profound advantage of not causing hemorrhage due to excessive fibrinolysis. In fact, its plasminogen activator is remarkably similar to the plasminogen activator in the tissues of other species. Toxicological experiments have found no negative effects of LK on nervous, cardiovascular, respiratory and blood systems of rats, rabbits and dogs. Long-term animal experiments show no damage to liver or kidney function, no negative influence on embryonic development, and no mutagenic effects in embryonic rats. LK has no negative effects on blood levels of glucose and lipids. And a 2001 study tested one of the six enzymes of LK to determine whether LK does indeed pass into the blood from the intestines while maintaining its biological activity. This research found that approximately 10% of the full-size enzyme could pass through the intestinal epithelium intact and into the blood. This is not surprising; research from The Hebrew University has shown that many peptides can pass intact and biologically active through the intestinal lumen into the blood.

In a laboratory experiment in 1994 from Seoul National University, lumbrokinase (the six enzymes) was extracted from the earthworm. LK was then immobilized onto a polyurethane surface to investigate its antithrombotic activity. Platelets adhered to the surface and then drastically decreased in number, suggesting that LK digested the fibrinogen and inhibited the ability of platelets to stick to the surface. Similar results were found with an experiment on a rabbit shunt in the laboratory; occlusion time was monitored and it was found that on shunts without LK, occlusion time was 32 and 42 minutes, respectively, but those with LK-immobilized polyurethane had an occlusion time of 140 minutes--as much as four times longer.

Such studies show the potential of immobilized-LK surfaces for eventual use in tissue transplantation. In one remarkable 1999 study, Lumbrokinase was tested on LK-immobilized polyurethane valves which were then fitted to total artificial hearts in three healthy lambs. In the control lamb, the valves were untreated; in the second lamb, only valves on the right were treated, and in the third lamb, only valves on the left were treated. Implants were left in for up to three days. In the control lamb, thrombi were observed in the inlet parts of the valves. In the other two lambs, thrombi formed only on untreated control valves. Similarly, fibrinolytic activity was observed only in treated valves, and the proteolytic activity of the treated valves was three times higher than that of untreated valves.

A Potent Clot-Dissolver

Animal studies have demonstrated that LK is a potent clot-dissolver. A study in rabbits looked at LK's ability to dissolve an embolism in the pulmonary artery. The embolism was radioactively tagged, and blood radioactivity was tested 30 minutes, one hour, two hours, three hours, and five hours after LK had been administered. Radioactivity increased markedly at three and five hours, indicating that LK had begun to dissolve the embolism and disperse it into the bloodstream. In another study rectal administration of LK reduced the size of a thrombus in the inferior vena cava in rats. And in yet another 1998 study, freeze dried Lumbricus rubellas was given to rats orally, and then plasmin activity in the blood was measured. At half a gram of LK per kilogram of weight a day, the activity doubled; at one gram, it quintupled. These results suggest that earthworm powder alone is valuable for thrombotic conditions. Finally, grafts treated with LK and inserted into the inferior vena cava of rabbits were compared to those not treated with LK, at five hours, 1, 2 and 4 weeks after implantation of the graft. Non-treated grafts were totally occluded with thrombus only five hours after implantation. LK treated graft were clear one week later, and those treated with a special covalent bonding method were clear four weeks later. Researchers concluded LK has potential antithrombotic effects in vascular prosthesis.

Lumbrokinase may help protect against myocardial ischemia and heart attack. A 2006 study in rats from Harbin Medical University in China induced heart attack in rats by permanently clamping shut the left anterior descending coronary artery. Lumbrokinase decreased the size of the infarct in a dose-dependent manner.

Human Studies Demonstrate Potency and Efficacy

Clinical trials in humans have been equally impressive. Research has found LK safe and effective as a thrombolytic in human volunteers. A hundred and twenty milligrams of freeze-dried earthworm powder was given orally to seven healthy volunteers aged 28-52 years old, three times a day for seventeen days. Blood was withdrawn before the trial to establish a baseline, and then at days 1, 2, 3, 8 , 11 and 17. Fibrin degradation products, tissue plasminogen activator (t-PA) levels and activity were measured in the blood. The t-PA levels gradually increased through the entire experiment. Fibrinolytic activity also increased.

In an even more significant study from Shanghai Medical University in 2000, LK was used in patients who had suffered a stroke. Fifty-one stroke victims were randomly divided into a treatment group (31) and a control group (20). The Chinese stroke score was used to evaluate the effect of LK. Several measures of blood viscosity were used--prothrombin time, fibrinogen content, tissue plasminogen activator (t-PA) activity, D-dimer level, and more. In the treatment group, t=PA activity and D-dimer level increased, while fibrinogen decreased significantly. Plasmingogen activator inhibitor activity and prothrombin time were unchanged. Lumbrokinase inhibits the coagulation pathway and activates fibrinolysis by increasing t-PA activity. This suggests that LK is not only beneficial for ischemic stroke, but that it may not increase the risk of excessive bleeding as anticoagulants can.

This stroke study is backed up by a 2008 study from Harbin Medical University in China. Researchers wondered how LK might have an anti-ischemic action in the brain. Using spectrofluorimeter and flow cytometry, they found that LK has both anti-platelet activity (by reducing calcium release), anti-thrombotic activity (by reducing intercellular adhesion molecule-1) and anti-apoptotic activity (by inhibiting a specific pathway). All these activities, the researchers conclude, were “remarkably regulated by LK.”

Future Directions: A New Antimicrobial?

Do earthworms hold other treasures for us? We know that plasmin has been implicated in wound healing, pathogen invasion, cancer invasion and metastasis. Might earthworms like Lumbricus rubellus also have antimicrobial and anti-cancer potential?

Preliminary research is intriguing. Lumbricin I is an antimicrobial peptide that has been isolated from Lumbricus rubellus. It exhibits antimicrobial activity against both Gram negative and Gram positive bacteria as well as fungi, yet without hemolytic activity against human blood cells. Lumbricin I is rich in proline and actually shares characteristics with peptides found in insects and fruit flies.

What about cancer? Earthworms are able to lyse and destroy foreign cells. As I mentioned at the beginning of this research review, I have been unable to provoke my earthworms into getting cancer. When earthworms are examined by electron microscopy their fabulous complexity is revealed. Researchers from Japan, Korea, China and Croatia have been studying how earthworm peptides may inhibit the growth of spontaneous tumors since the 1990's. One “killer” glycolipoprotein extract called G-90 retards tumor growth in mice. Lombricine, from Lumbricus terrestris, was purified by Japanese researchers in 1991, and was shown to inhibit mammary tumors in mice. Daily subcutaneous injections markedly slowed the growth of tumors. Lombricine given orally as part of the diet also slowed the growth of tumors, though to a lesser degree than injection.

In addition, LK may help degrade and lyse fibrin clots from the venous blood of patients with malignant tumors. We know that cancer patients are at greater risk of clotting disorders, especially during treatment. According to research, malignant tumors secretes molecules that inhibit plasminogen activators and protect tumors. Might earthworm-derived enzymes like LK combat a tumor's protective mechanisms, and render it more vulnerable to treatment and to the innate immune system?

The Future of Earthworms as Medicine

We now know that earthworm enzymes and peptides may provide us with novel, potent and safe approaches to the treatment of thrombosis. Since thrombosis remains the main cause of death in America despite available drugs, the potential of LK is enormous. I think back to my boyhood, when I refused to fish, so I would not have to inadvertently kill earthworms by using them as lure. But I never knew that my commitment to developmental biology and comparative immunology would lead me to study these simple, profound creatures.

References available at:

http://www.allergyresearchgroup.com/Mar-2009-Focus-Newsletter-Earthworm-References-sp-93.html

BAT Fat Keeps You Thin

By Ronald Hoffman, MD

It's a fat that bats have, but in med school we were taught adult humans lacked it. It's Brown Adipose Tissue (BAT). Found in many mammals, especially rodents, BAT is what keeps them warm because of its accelerated fat-burning capabilities. Unlike the more prevalent yellow blobby ("white") fat that predominates in obesity, it has a rapid metabolic rate.

Babies are known to have brown fat as a means of cold-adaptation because they can't shiver (most warm-blooded animals don't either). But in breakthrough research, the New England Journal of Medicine announced this week that adult humans have it, too.

How does brown fat rev the body's metabolic machinery? The answer is complex, but offers some insights into thyroid physiology. The main source of thyroid hormone, or T4, must be converted to T3 within the mitochondria inside cells to set the rate of metabolism and fat-burning. In brown fat, the T4 to T3 conversion is in overdrive, resulting in thermogenesis, or fat-burning.

This is why complementary docs often favor thyroid replacement with T4/T3 combinations instead of straight T4, as is found in Synthroid. Dosing with pre-formed T3 simulates the conversion that occurs in brown fat. But too much T3 can result in jitteriness and heart arrhythmias.

Overweight rodents are in luck these days. Scientists have developed a slew of prospective weight loss drugs that are dramatically effective in mice and rats. But because rodents have brown fat and humans were said not to have it, the experimental drugs disappoint in humans.

Now research shows that brown fat does not entirely disappear in adulthood. Small amounts of it are present in healthy, trim individuals. In overweight folks with hallmarks of metabolic slow-down like high cholesterol and Syndrome X, it has virtually disappeared.

So what are the practical implications? Are there ways we can enhance brown fat?

Remarkably, the New England Journal researchers have found a partial answer: Just CHILL!

In a series of experiments, they exposed healthy adults to cold temperatures. We're not even talking the Polar Bear Club here. Sitting around in light clothing for a couple of hours at temperatures around 60, or immersing feet in cold (not ice) water produced a detectable increase in brown fat, and it happened within just days!

Now, I'm thinking to myself, am I aspiring to rodent-hood? I make a point of turning off the radiators in winter, opening windows, and dialing down the thermostat to 60 or 62. I challenge myself to frigid runs in twenty-degree temperatures throughout winter. While I don't go so far as to take cold showers, I regularly swim in Shinnecock Bay after water temperatures top 60 around Memorial Day. Maybe I'm stoking my metabolism and building brown fat stores while saving the planet and reducing my carbon footprint!

It may be that one way that modern civilization conspires to make us fat is by shielding us from the evolutionary anvil of cold which honed the metabolisms of our ancestors for millennia. We sit in toasty homes, commute to work in cozy cars with seat warmers, and if we work out, we do so in heated gyms or tepid swimming pools.

Another take-home from the New England Journal research: Certain drugs rev brown fat, especially amphetamines. But their addictive properties and side effects make their use undesirable. According to the articles, natural ephedra works well, too, but it's been banned, despite a track record of mostly safe use among responsible users. EGCG from green tea may also hit brown fat receptors, and it's still available.

Unfortunately, there are drugs that shrink brown fat, thus slowing metabolism. The sad fact is that they are routinely prescribed to tens of millions of Americans. They are the beta-blockers, dished liberally for heart disease and hypertension, and the benzodiazepines, medicine's main remedies for anxiety. Common examples include Inderal, Lopressor, Toprol, Zebeta, Tenormin, and Valium, Ativan, Xanax, Halcion, and Klonipin.

So, for now, barring any major breakthroughs on the fat-drug front, embrace the cold, and try to stay healthy enough to eschew medications that are metabolic downers.

Vitamin D Deficiency and Tooth Decay

By Gina Nick, NMD

Here is yet another reason to consider getting tested for, and supplementing with Vitamin D3…I am re-printing a report released by the Orthomolecular Medical Society that discusses the connection between how much vitamin D3 you have in your body, and tooth decay, Alzheimer’s disease, respiratory infections, cancer, heart disease, diabetes and other ailments.  This is one of many essential nutrients that the body needs to function properly.   And it happens to be an inexpensive therapy that helps to prevent and  treat some of the most expensive diseases of our time like heart disease, cancer and diabetes. Vitamin D3 works synergistically with vitamin K and calcium to increase bone mineral density in women with osteoporosis. Some whole food sources include organic egg yolks, raw, organic butter (preferably from goat rather then cow), and cod liver oil.

-Dr. G

Vitamin Deficiency Underlies Tooth Decay
Malnutrition Causes Much More than Dental Disease

Cavities and gum diseases are not often regarded as serious diseases, yet they are epidemic throughout our society, from the youngest of children to the oldest of senior citizens. Research more than suggests that the same good nutrition that prevents cavities and gum diseases may also prevent other illnesses.

Dental caries and gum pathology are frequently associated with serious chronic health problems. Multiple independent studies published after 1990 document this. Cavities are associated with poor mental health [1-4]. Elderly individuals with dementia or Alzheimer’s disease had an average of 7.8 teeth with fillings vs. an average of only 2.7 fillings for elderly individuals without dementia [1]. It is likely that the toxic heavy metal mercury, which makes up half of every amalgam filling, is a contributing factor.

A recent authoritative review showed a clear association between cavities and heart diseases [5]. More importantly, this same study showed that people with poor oral health, on average, lead shorter lives. The association between cavities and diabetes is also a subject of active, ongoing research [6-8]. Connections between heart disease, diabetes, and dental decay have been suspected for decades. Many of the scientists who called attention to this have proposed that diets high in sugar and refined carbohydrates were the common cause of these diseases [9-15].

Dental diseases, mental diseases, heart disease, infectious respiratory diseases, and heart disease are all at least partially caused by common failures in metabolism. Such failures are inevitable when there is a deficiency of essential nutrients, particularly vitamins D, C, and niacin.

There is especially strong evidence for a relationship between vitamin D deficiency and cavities. Dozens of studies were conducted in the 1930’s and 1940’s [16-27]. More than 90% of the studies concluded that supplementing children with vitamin D prevents cavities. Particularly impressive was a study published in 1941 demonstrated the preventative affect of “massive” doses of vitamin D [28]. And yet no subsequent studies in the scientific literature suggested a need to follow up and repeat this work.

Vitamin D deficiency is linked to respiratory infections, cancer, heart disease, diabetes and other ailments [29]. The evidence for vitamin C was reviewed by Linus Pauling [15], and the evidence for niacin was reviewed by Abram Hoffer [30].

Obtaining vitamins in sufficient doses to help prevent dental disease is safe and easily accomplished. Between 5,000 and 15,000 IU of vitamin D may be obtained from modest exposure to sunshine in the middle of the day. Recommending that people regularly use the capacity of their skin to make vitamin D is common sense. Certainly 1,000 to 2,000 IU per day of vitamin D in supplemental form is safe. 2,000 milligrams per day of vitamin C, and hundreds of milligrams per day of niacin, help prevent tooth and mouth troubles. Sick individuals, and those who are prone to cavities, will typically benefit by starting with higher doses of vitamin D, vitamin C, and niacin under the supervision of an orthomolecular physician.

We believe that individuals taking these nutrients, along with good dental care, will have dramatically fewer cavities and gum operations than individuals just getting good dental care. This idea is easily tested, and the time has come to do so.

References:

[1] B Ellefsen; P Holm-Pedersen; D E Morse; M. Schroll; B. Andersen; G. Waldemar. Caries Prevalence in Older Persons with and without Dementia. Journal of the American Geriatrics Society, Volume 56, Number 1, January 2008, 59-67(9).
[2] J M Chalmers, K D Carter, A J Spencer. Caries incidence and increments in community-living older adults with and without dementia. Australian Research Center for Population Oral Health, Dental School, The University of Adelaide, Adelaide 5005, Australia. Gerodontology Volume 19 Issue 2, 80 - 94.
[3] Friedlander, A.H.; Mahler, M.E. Major depressive disorder psychopathology, medical management and dental implications. Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System (14), Los Angeles, CA, USA. Journal of the American Dental Association (2001), 132(5), 629-638.
[4] Stewart, R.; et. al. Oral Health and Cognitive Function in the Third National Health and Nutrition Examination Survey (NHANES III), Psychosomatic Medicine 70:936-941 (2008).
[5] Meurman, J.H.; Sanz, M.;Janket, S. Oral infection and vascular disease. Institute of Dentistry, University of Helsinki, Finland. Vascular Disease Prevention (2007), 4(4), 260-267.
[6] Touger-Decker R, Sirois D A, Vernillo A T. Diabetes mellitus: Nutrition and oral health relationships. Department of Primary Care, School of Health-Related Professions, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA. Editor(s): Touger-Decker, Riva. Nutrition and Oral Medicine (2005), 185-204.
[7] Diaz-Romero, R.; Casanova-Roman, R.; Beltran-Zuniga, M; Belmont-Padilla, J.; Mendez, J.; Avila-Rosas, H.. Oral Infections and Glycemic Control in Pregnant Type 2 Diabetics. Instituto Nacional de Perinatologia, Mexico City, Mex. Archives of Medical Research (2005), 36(1), 42-48.
[8] Twetman, S.; Johansson, I.; Birkhed, D.; Nederfors, T. Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and caries-associated risk factors. Caries Research (2002), 36(1), 31-35.
[9] Bommer, S. Diseases of civilization and nutrition. Ernaehrungsforschung (1963), 7 598-612.
[10] Miler-Sosnkowska, M. Role of dietary carbohydrates in relation to their metabolism. Inst. Zywienia Czlowieka, Akad. Roln., Warsaw, Pol. Postepy Higieny i Medycyny Doswiadczalnej (1975), 29(4), 537-55.
[11] Cremer, H.D.; Eyer, H. Carbohydrates. Inst. Ernaehrungswiss. I, Univ. Giessen, Giessen, Fed. Rep. Ger. Ernaehrungs-Umschau (1975), 22(10), 291-3.
[12] Newberne, P.M.. Nutrition: summary of evidence. Sweeteners: Issues, uncertainties. Acad. Forum, 4th (1975), 76-85, 252-3.
[13] Heraud, G. Sucrose and nutritional pathology. Sucrerie Francaise (1979), 120(24), 21-6.
[14] Nuttall, F.Q.; Gannon, M.C.. Sucrose and disease. Diabetes Care (1981), 4(2), 305-10.
[15] Pauling, L. “How to Live Longer and Feel Better.” W.H. Freeman and Company, 1986. Revised 2006, Oregon State University Press. http://oregonstate.edu/dept/press/g-h/LiveLonger.html
[16] Tisdall, F.F. The effect of nutrition on the primary teeth. Child Development (1937) 8(1), 102-4.
[17] McBeath, E.C. Nutrition and diet in relation to preventive dentistry. NY J. Dentistry (1938) 8; 17-21.
[17] McBeath, E.C.; Zucker, T.F. Role of vitamin D in the control of dental caries in children. Journal of Nutrition (1938) 15; 547-64.
[19] East, B. R. Nutrition and dental caries. American Journal of Public Health 1938. 28; 72-6.
[20] Mellanby, M. The role of nutrition as a factor in resistance to dental caries. British Dental Journal (1937), 62; 241-52.
[21] His Majesty’s Stationery Office, London. The influence of diet on caries in children’s teeth. Report of the Committee for the Investigation of Dental Disease (1936).
[22] McBeath, F.C. Vitamin D studies, 1933-1934. American Journal of Public Health (1934), 24 1028-30.
[23] Anderson, P. G.; Williams, C. H. M.; Halderson, H.; Summerfeldt, C.; Agnew, R. Influence of vitamin D in the prevention of dental caries. Journal of the American Dental Association (1934) 21; 1349-66.
[24] Day, C. D.; Sedwick, H. J. Fat-soluble vitamins and dental caries in children. Journal of Nutrition (1934) 8; 309-28.
[25] Agnew, M. C.; Agnew, R. G.; Tisdall, F. F. The production and prevention of dental caries. Journal of the American Dental Association, JADA (1933) 20; 193-212.
[26] Bennett, N. G.; et al. The influence of diet on caries in children’s teeth. Special Report Series - Medical Research Council, UK (1931) No. 159, 19.
[27] Mellanby, M.; Pattison, C. L. The influence of a cereal-free diet rich in vitamin D and calcium on dental caries in children. British Medical Journal (1932) I 507-10.
[28] Brodsky, R. H.; Schick, B.; Vollmer, H.. Prevention of dental caries by massive doses of vitamin D. American Journal of Diseases of Children (1941) 62; 1183-7.
[29] http://www.vitamindcouncil.org/
[30] Hoffer A, Saul AW. Orthomolecular Medicine for Everyone. Laguna Beach, California, Basic Health Pub, 2008. http://www.doctoryourself.com/orthomolecular.html

Asking the right questions in a tough economy

Demand for medicine and medical treatment is somewhat inelastic.  However, like other successful business owners, physicians must continue to scrutinize expenses in the coming months.  Malpractice insurance is one variable expense that can directly impact your bottom line.  To be cliché, a little work can go a long way.  The first thing to do is review your current policy.  When you’re looking it over, ask yourself these questions:

1. Am I covered properly for my specialty?
2. Are my limits reasonable for my practice?
3. Am I’m rated part-time or full-time?
4. Have I shopped around recently for the best deal?
5. Does my insurance company continuously work with me to ensure comprehensive coverage?

It can be all too easy to take shortcuts when purchasing insurance.  Ironically, when a physician prematurely asks the question “How much does it cost?” they’re making a costly mistake.  Getting the right coverage for the right price is a process and it begins with questions like the ones I’ve suggested.  Medical malpractice insurance is a compounding investment that requires due diligence and patience.  So the next time you’re out shopping for insurance use these questions to focus on value and not just price. 

Make the right choice, 

Dave C. Thorson,

Director 

Fairway Physicians Insurance Company

A Risk Retention Group